The E&M Audit

Physician practice audits assess the accuracy of E&M coding. To put your attention where it's needed most, audit findings focus on significant discrepancies which impact on the E&M level and RBRVS payment. All coding changes suggested are backed up by citations from the medical record and reliable, definitive sources for coding guidelines. Audits can be scheduled on a regular, recurring basis or as a one-time review.

The E&M Audit Process

Sample Selection : Sample selection varies depending on your preference. You may select all cases or leave the selection to Clarity Coding. A combination approach may also be used. Although troublesome cases may be one focus in the selection, a random element should always be a feature of the case selection.

Case Review : For each case selected, we assign the E&M code supported by the documentation in accordance with CMS's 1995 Documentation Guidelines or 1997 Documentation Guidelines for Evaluation and Management Services. For each case, the reviewers document their code assignment by completing the E/M Documentation Auditors worksheet commonly used by Medicare carriers. The reviewers then compare their assigned E&M code to the code assigned by the practice. This idenitfies areas of discrepancy in either documentation or case review which lead to differing codes.

Results: Results are two-part. The first is a list of all cases reviewed displaying the code assigned by the practice, the code assigned by Clarity Coding, and a statement detailing the nature of any discrepancy. The second is a summary of the discrepancies with recommendations for improvements in documentation and coding practice.